diclofenac + methotrexate + sulfasalazine

This is a combination regimen of three drugs—diclofenac, methotrexate, and sulfasalazine—used primarily in the management of rheumatoid arthritis (RA) and other inflammatory conditions. Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase-1 and -2 enzymes, reducing prostaglandin synthesis to alleviate pain and inflammation. Methotrexate is a disease-modifying antirheumatic drug (DMARD) that acts as an antifolate immunosuppressant by inhibiting dihydrofolate reductase, thereby suppressing immune activity. Sulfasalazine is another DMARD with an incompletely understood mechanism; it may modulate inflammatory mediators such as nuclear factor kappa-B and deplete folates. This triple therapy approach can be used when monotherapy or dual therapy does not adequately control RA symptoms[1][5][7]. The combination aims to maximize disease control by targeting different pathways involved in inflammation.